A case report of achalasia and large epiphrenic diverticulum treated by peroral endoscopic myotomy combined with diverticuloseptotomy





diverticulum, achalasia, POEM, esophagus


The combination of esophageal achalasia with epiphrenic diverticulum is extremely rare and mostly treated surgically. Several cases of successful endoscopic treatment were presented in the literature, but treatment strategy has not yet been defined.

Aim. To present a case of the rare combination as achalasia and giant esophageal epiphrenic diverticulum successfully treated endoscopically.

Case report. We present to your attention a case report of a 75-year-old woman with complete dysphagia, significant weight loss, who was diagnosed with symptomatic epiphrenic diverticulum secondary to achalasia. Upper gastrointestinal endoscopy showed signs of severe fibrosis in the submucosal layer of the diverticulum. She received peroral endoscopic myotomy combined with diverticuloseptotomy made from the same submucosal tunnel. The regression of symptoms from 10 to 2 points according to the Eckardt symptom score clinically showed the treatment success.

Conclusions. The presented endoscopic one-tunnel technique could be an effective miniinvasive option for large symptomatic epiphrenic diverticula associated with achalasia.

Author Biographies

O. M. Kiosov, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

MD, Assistant of the Department of Faculty surgery; Head of Multidisciplinary Surgical Department, University Clinic of Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

V. S. Tkachov, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

MD, PhD student of the Department of Faculty Surgery; Endoscopist at Multidisciplinary Surgical Department, University Clinic of Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

S. M. Hulevskyi, University Clinic of Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

MD, Endoscopist at Multidisciplinary Surgical Department

M. V. Korobov, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

MD, intern at the Department of General Surgery and Postgraduate Surgery Education


Sato, H., Takeuchi, M., Hashimoto, S., Mizuno, K. I., Furukawa, K., Sato, A., Yokoyama, J., & Terai, S. (2019). Esophageal diverticulum: New perspectives in the era of minimally invasive endoscopic treatment. World journal of gastroenterology, 25(12), 1457-1464. https://doi.org/10.3748/wjg.v25.i12.1457

Chan, D. S. Y., Foliaki, A., Lewis, W. G., Clark, G. W. B., & Blackshaw, G. R. J. C. (2017). Systematic Review and Meta-analysis of SurgicalTreatment of Non-Zenker's Oesophageal Diverticula. Journal of gastrointestinal surgery, 21(6), 1067-1075. https://doi.org/10.1007/s11605-017-3368-3

Shiu, S. I. (2021). Parapneumonic Effusion and Tension Pneumothorax after Diverticular Peroral Endoscopic Myotomy in a Woman with Large Epiphrenic Diverticulum: A Case Report and Literature Review. Clinical endoscopy, 54(2), 275-279. https://doi.org/10.5946/ce.2020.093

Martinek, J., Svecova, H., Vackova, Z., Dolezel, R., Ngo, O., Krajciova, J., Kieslichova, E., Janousek, R., Pazdro, A., Harustiak, T., Zdrhova, L., Loudova, P., Stirand, P., & Spicak, J. (2018). Per-oral endoscopic myotomy (POEM): mid-term efficacy and safety. Surgical endoscopy, 32(3), 1293-1302. https://doi.org/10.1007/s00464-017-5807-3

Fisichella, P. M., Jalilvand, A., & Dobrowolsky, A. (2015). Achalasia and epiphrenic diverticulum. World journal of surgery, 39(7), 1614-1619. https://doi.org/10.1007/s00268-015-2950-7

Wu, C., Zhang, Q., Liu, W., & Hu, B. (2018). Successful treatment of giant esophageal diverticulum by per-oral endoscopic myotomy. Endoscopy, 50(5), E107-E108. https://doi.org/10.1055/s-0043-125310

Nadaleto, B. F., Herbella, F. A. M., & Patti, M. G. (2022). Treatment of Achalasia and Epiphrenic Diverticulum. World journal of surgery, 46(7), 1547-1553. https://doi.org/10.1007/s00268-022-06476-2

Allaix, M. E., Borraez Segura, B. A., Herbella, F. A., Fisichella, P. M., & Patti, M. G. (2015). Is resection of an esophageal epiphrenic diverticulum always necessary in the setting of achalasia?. World journal of surgery, 39(1), 203-207. https://doi.org/10.1007/s00268-014-2770-1

Kinoshita, M., Tanaka, S., Kawara, F., Sakaguchi, H., Abe, H., Ariyoshi, R., Toyonaga, T., & Kodama, Y. (2020). Peroral endoscopic myotomy alone is effective for esophageal motility disorders and esophageal epiphrenic diverticulum: a retrospective single-center study. Surgical endoscopy, 34(12), 5447-5454. https://doi.org/10.1007/s00464-019-07340-6

Beyna, T., Kandler, J., & Neuhaus, H. (2018). Per-oral endoscopic myotomy and simultaneous diverticuloseptotomy in coincident epiphrenic diverticulum and achalasia. VideoGIE, 4(2), 62-65. https://doi.org/10.1016/j.vgie.2018.09.019

Inoue, H., Minami, H., Kobayashi, Y., Sato, Y., Kaga, M., Suzuki, M., Satodate, H., Odaka, N., Itoh, H., & Kudo, S. (2010). Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy, 42(4), 265-271. https://doi.org/10.1055/s-0029-1244080

Kahrilas, P. J., Katzka, D., & Richter, J. E. (2017). Clinical Practice Update: The Use of Per-Oral Endoscopic Myotomy in Achalasia: Expert Review and Best Practice Advice From the AGA Institute. Gastroenterology, 153(5), 1205-1211. https://doi.org/10.1053/j.gastro.2017.10.001

Manolakis, A. C., Inoue, H., Ueno, A., & Shimamura, Y. (2019). 2007-2019: a "Third"-Space Odyssey in the Endoscopic Management of Gastrointestinal Tract Diseases. Current treatment options in gastroenterology, 17(2), 202-220. https://doi.org/10.1007/s11938-019-00233-6

Yang, J., Zeng, X., Yuan, X., Chang, K., Sanaei, O., Fayad, L., Kumbhari, V., Singh, V., Kalloo, A. N., Hu, B., & Khashab, M. A. (2019). An international study on the use of peroral endoscopic myotomy (POEM) in the management of esophageal diverticula: the first multicenter D-POEM experience. Endoscopy, 51(4), 346-349. https://doi.org/10.1055/a-0759-1428

Demeter, M., Ďuriček, M., Vorčák, M., Hyrdel, R., Kunda, R., & Bánovčin, P. (2020). S-POEM in treatment of achalasia and esophageal epiphrenic diverticula - single center experience. Scandinavian journal of gastroenterology, 55(4), 509-514. https://doi.org/10.1080/00365521.2020.1745881



How to Cite

Kiosov OM, Tkachov VS, Hulevskyi SM, Korobov MV. A case report of achalasia and large epiphrenic diverticulum treated by peroral endoscopic myotomy combined with diverticuloseptotomy. Zaporozhye Medical Journal [Internet]. 2023May31 [cited 2024Jun.22];25(3):270-3. Available from: http://zmj.zsmu.edu.ua/article/view/276190